Drug Coverage

The Biosimilars Forum Board of Directors recently appointed Juliana M. Reed as its new executive director and Formulary Watch got the scoop from Reed first hand.

Price increases on promising non–small cell lung cancer drugs despite evidence price competition raise concerns about affordability.

The new Medi-Cal Rx program that debuted Jan. 1 has alarmed health clinics that say the state's Medicaid will lose money and have to cut services.

United States healthcare spending rose 9.7% in 2020, while medication spending is increasing by more than 18%.

In a research letter published in JAMA Health Forum, researchers say most of the cost figures for Aduhelm have left out the additional MRI scans and other services that will be required because the drug is associated with the development of amyloid-related imaging abnormalities (ARIAs).

Lecanemab and donanemab, monoclonal antibodies for Alzheimer’s, are on the list of drugs in late-stage development that Clarivate analysts will have annual sales of a $1 billion or more in the next five years.

During the period 2015 to 2020, if a proposed policy that increases Medicaid rebates for drugs with accelerated approvals had been enacted, up to $5.2 billion could have been saved.

Researchers suggest that adjusting the prescribing patterns of about 8% of physicians could result in substantial savings.

Livtencity, manufactured by Takeda, was approved in November 2021 and is the first therapy to treat cytomegalovirus infection after transplants.

CMS is not requiring payment for pharmacists’ testing, patient assessment, ordering/prescribing and dispensing for oral COVID-19 antiviral drugs.

ICER’s first scorecard of the barriers to fair access to medications found that more transparency is needed to fully assess insurers and their coverage policies.

Findings show substantial variation in payer-negotiated prices and self-pay cash prices at top-performing U.S. hospitals and considerable markups on clinician-administered drugs.

Across all payers, the use of generic statins has resulted in a savings of $11.9 billion annually.

Patients who are part of the Walgreen’s Prescription Savings Club can receive Semglee at up to 80% off the cash price.

OptumRx will favor the reference product Lantus on the Premium Formulary. The organization also released coverage information about other newly approved therapies.

Besremi was approved recently to treat a rare blood disease.

ICER’s review indicates that Humira’s price increases are not supported by new clinical evidence.

A reimbursement policy similar to that used for branded and generic drugs would have saved $1.6 billion from 2015 to 2019.

Smaller PBMs are rated higher by health plans in terms of satisfaction because of their ability to offer more customized solutions.

Half of the step therapy protocols for specialty drugs evaluated by investigators go beyond what is suggested in treatment guidelines.

CVS Caremark has removed 10 branded products from its formulary and added about 30 additional products.

This Tufts study has found that plans that restrict orphan drugs do so by narrowing the patient population who can receive them.

Prime’s formularies will include the insulin biosimilar over the reference product Lantus beginning in January 2022.

Several generics of the cancer therapeutic are available.

EmsanaRx, the new PBM, aims to provide large employers with flexibility and transparency on drug spending.

Specialty drug prices are rising as these therapeutics replace lower-cost therapies.

Cigna plans to remove 45 drugs from its Standard Prescription Drug List and add restrictions for other therapeutics.

Cumulative spending on drugs without overall survival data was $1.8 billion in 2018 and surpassed that of drugs with such data.

Specialty medicines are now 53% of spending, up from 27% in 2010 and driven by growth in autoimmune and oncology therapies.